NPIMap

Organization Active NPI

Broadstep Academy-Illinois Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Freeport, IL
National Provider Identifier
1093919797
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
03C004 Issued in IL
Legal business name
BROADSTEP ACADEMY-ILLINOIS INC
Practice address
239 Winnefred St.
Freeport, IL 61032
Phone
(815) 235-8071
NPI assigned
Jun 14, 2007
Last updated
Aug 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kedrian Coleman
Title
Director Revenue Cycle
Phone
(919) 709-0197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 03C004 IL Primary

Addresses

Primary practice location

239 Winnefred St.
Freeport, IL 61032

Mailing address

701 W Lamm Rd
Freeport, IL 61032-9630
Phone (815) 233-6162

National Provider Directory

National Provider Directory
Tax ID family
Broadstep Academy-Illinois Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1093919797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W LAMM RD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610329630",
            "telephone_number": "815-233-6162",
            "fax_number": "815-233-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 WINNEFRED ST.",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-235-8071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADSTEP ACADEMY-ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "KEDRIAN",
        "authorized_official_title_or_position": "DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "919-709-0197"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "03C004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.